Friday, April 18, 2014

Autism: Diagnosis and Treatment

In the US April is National Autism Awareness Month.

The Child Development Clinic at Children's Hospital of Richmond at VCU (CHoR) provides comprehensive assessment for pediatric patients with developmental delays or disabilities, including those with autism spectrum disorders.

The medical, psychological, social work and educational testing offered by the clinic leads to a diagnosis and recommendations to help patients and their health care providers with care planning, referrals, follow-up care coordination and treatments.

Pasquale Accardo
We sat down with Pasquale Accardo, M.D., professor and chief of the Division of Developmental Pediatrics at CHoR, to learn more about autism, including symptoms, diagnosis and treatment.

What is autism?

Autism is a neurodevelopmental disorder, this means that it is a chronic brain problem, a difficulty that the brain has with processing certain kinds of information.

In the case of autism, typically the greatest difficulty is dealing with social interaction.

What are the common signs and symptoms of autism?

Common signs of autism vary with age:

  • Young children often first present with language issues.
  • Preschool and school-age children often exhibit attention deficit hyperactivity disorder (ADHD) symptoms and other challenging behaviours.
  • Older children have significant socialization problems, repetitive and obsessive compulsive behaviours.

Symptoms of autism do change with time; certain delays are more common in younger children whereas socialization and processing problems are more common in older children and adults.

How is autism diagnosed?

Autism is diagnosed using a variety of approaches:

How is autism treated?

Autism is best treated with a variety of Early Intensive Behavioural Interventions (EIBI); speech language therapy and occupational therapy can also be used.

Applied Behaviour Analysis (ABA) is considered the standard for behavioral intervention, but most other effective behavioral programs are variants on ABA.

Tuesday, April 15, 2014

Autism: Parents advised to get a dog

Many families face the decision of whether to get a dog.

For families of children with autism, the decision can be even more challenging.

Now, a University of Missouri researcher has studied dog ownership decisions in families of children with autism and found, regardless of whether they owned dogs, the parents reported the benefits of dog ownership included companionship, stress relief and opportunities for their children to learn responsibility.

"Children with autism spectrum disorders often struggle with interacting with others, which can make it difficult for them to form friendships," said Gretchen Carlisle, a research fellow at the Research Center for Human-Animal Interaction (ReCHAI) in the MU College of Veterinary Medicine.

"Children with autism may especially benefit from interacting with dogs, which can provide unconditional, nonjudgmental love and companionship to the children."

Carlisle interviewed 70 parents of children with autism. Nearly two-thirds of the parents in the study owned dogs, and of those parents, 94 percent reported their children with autism were bonded to their dogs.

Even in families without dogs, 70 percent of parents said their children with autism liked dogs.

Many dog-owning parents said they specifically chose to get dogs because of the perceived benefits to their children with autism, Carlisle said.

"Dogs can help children with autism by acting as a social lubricant," Carlisle said. "For example, children with autism may find it difficult to interact with other neighbourhood children."

"If the children with autism invite their peers to play with their dogs, then the dogs can serve as bridges that help the children with autism communicate with their peers."

Parents of children with autism should consider their children's sensitivities carefully when choosing a dog in order to ensure a good match between pet and child, Carlisle said.

"Bringing a dog into any family is a big step, but for families of children with autism, getting a dog should be a decision that's taken very seriously," Carlisle said.

"If a child with autism is sensitive to loud noises, choosing a dog that is likely to bark will not provide the best match for the child and the family."

"If the child has touch sensitivities, perhaps a dog with a softer coat, such as a poodle, would be better than a dog with a wiry or rough coat, such as a terrier."

Carlisle recommends parents involve their children with autism when choosing a dog.

"Many children with autism know the qualities they want in a dog," Carlisle said. "If parents could involve their kids in choosing dogs for their families, it may be more likely the children will have positive experiences with the animals when they are brought home."

Although her study only addressed dog ownership among families affected by autism, Carlisle said dogs might not be the best pet for every child with autism.

"If you know one child with autism, you know one child with autism," Carlisle said. "Dogs may be best for some families, although other pets such as cats, horses or rabbits might be better suited to other children with autism and their particular sensitivities and interests."

"This research adds scientific credibility to the benefits of human-animal interaction," said Rebecca Johnson, a professor at the MU College of Veterinary Medicine, director of ReCHAI, and the Millsap Professor of Gerontological Nursing in the MU Sinclair School of Nursing.

"This research helps us understand the role of companion animals in improving the lives of children with autism and helps health professionals learn how to best guide families in choosing pets for their families."

The study, "Pet Dog Ownership Decisions for Parents of Children With Autism Spectrum Disorder," was published in the Journal of Pediatric Nursing earlier this year.

SIDS: New insight into cot deaths points to lack of oxygen

Research at the University of Adelaide has shed new light onto the possible causes of sudden infant death syndrome (SIDS), which could help to prevent future loss of children's lives.

In a world-first study, researchers in the University's School of Medical Sciences have found that telltale signs in the brains of babies that have died of SIDS are remarkably similar to those of children who died of accidental asphyxiation.

"This is a very important result. It helps to show that asphyxia rather than infection or trauma is more likely to be involved in SIDS deaths," says the leader of the project, Professor Roger Byard AO, Marks Professor of Pathology at the University of Adelaide and Senior Specialist Forensic Pathologist with Forensic Science SA.

The study compared 176 children who died from head trauma, infection, drowning, asphyxia and SIDS.

Researchers were looking at the presence and distribution of a protein called â-amyloid precursor protein (APP) in the brain.

This "APP staining", as it's known, could be an important tool for showing how children have died. This is the first time a detailed study of APP has been undertaken in SIDS cases.

"All 48 of the SIDS deaths we looked at showed APP staining in the brain," Professor Byard says.

"The staining by itself does not necessarily tell us the cause of death, but it can help to clarify the mechanism.

"The really interesting point is that the pattern of APP staining in SIDS cases - both the amount and distribution of the staining - was very similar to those in children who had died from asphyxia."

Professor Byard says that in one case, the presence of APP staining in a baby who had died of SIDS led to the identification of a significant sleep breathing problem, or apnoea, in the deceased baby's sibling.

"This raised the possibility of an inherited sleep apnoea problem, and this knowledge could be enough to help save a child's life," Professor Byard says.

"Because of the remarkable similarity in SIDS and asphyxia cases, the question is now: is there an asphyxia-based mechanism of death in SIDS? We don't know the answer to that yet, but it looks very promising."

This study was conducted at the University of Adelaide by visiting postdoctoral researcher Dr Lisbeth Jensen from Aarhus University Hospital, Denmark, and was funded by SIDS and Kids South Australia.

The results have been published in the journal Neuropathology and Applied Neurobiology.

"This work also fits in very well with collaborative research that is currently being undertaken between the University of Adelaide and Harvard University, on chemical changes in parts of the brain that control breathing," Professor Byard says.

Monday, April 14, 2014

ADHD/ADD: Confirmation of the neurobiological origin

In this image, marking shows the axons in retinal neurons (in red) that innervate the superior colliculus (in blue) in a "normal" mouse. 

Credit: Michael Reber / Institut des Neurosciences Cellulaires et Intégratives 

A study, carried out on mice, has just confirmed the neurobiological origin of attention-deficit disorder (ADD), a syndrome whose causes are poorly understood.

Researchers from CNRS, the University of Strasbourg and INSERM have identified a cerebral structure, the superior colliculus, where hyperstimulation causes behaviour modifications similar to those of some patients who suffer from ADD.

Their work also shows noradrenaline (Norepinephrine) accumulation in the affected area, shedding light on this chemical mediator having a role in attention disorders.

These results are published in the journal Brain Structure and Function.

Attention-deficit disorder (ADD/ADHD) affects between 4-8% of children. It manifests mainly through disturbed attention and verbal and motor impulsiveness, sometimes accompanied by hyperactivity.

About 60% of these children still show symptoms in adulthood. No cure exists at this time. The only effective treatment is to administer psychostimulants, but these have substantial side effects, such as dependence.

Persistent controversy surrounding the neurobiological origin of this disorder has hindered the development of new treatments.

The study in Strasbourg investigated the behaviour of transgenic mice having developmental defects in the superior colliculus.

This structure, located in the midbrain, is a sensory hub involved in controlling attention and visual and spatial orientation.

The mice studied were characterized by duplicated neuron projections between the superior colliculus and the retina. This anomaly causes visual hyperstimulation and excess noradrenaline in the superior colliculus.

The effects of the neurotransmitter noradrenaline (Norepinephrine), which vary from species to species, are still poorly understood.

However, we do know that this noradrenaline (Norepinephrine) imbalance is associated with significant behavioural changes in mice carrying the genetic mutation.

By studying them, researchers have observed a loss of inhibition: for example mice hesitate less to penetrate a hostile environment.

They have difficulties in understanding relevant information and demonstrate a form of impulsiveness. These symptoms remind us of adult patients suffering from one of the forms of ADD.

Currently, the fundamental work on ADD uses mainly animal models obtained by mutations that disturb dopamine production and transmission pathways. In mice with a malformed superior colliculus, these pathways are intact.

The changes occur elsewhere in the neural networks of the midbrain. By broadening the classic boundary used to research its causes, using these new models would allow a more global approach to ADD to be developed.

Characterising the effects of noradrenaline (Norepinephrine) on the superior colliculus more precisely could open the way to innovative therapeutic strategies.

More information: Chantal Mathis, Elise Savier, Jean-Bastien Bott, Daniel Clesse, Nicholas Bevins, Dominique Sage-Ciocca, Karin Geiger, Anaïs Gillet, Alexis Laux-Biehlmann, Yannick Goumon, Adrien Lacaud, Vincent Lelièvre, Christian Kelche, Jean-Christophe Cassel, Frank W. Pfrieger, Michael Reber. "Defective response inhibition and collicular noradrenaline enrichment in mice with duplicated retinotopic map in the superior colliculus." Brain Structure and Function, 2014; DOI: 10.1007/s00429-014-0745-5

Tuesday, April 1, 2014

Bullying affects most Adolescents, Popularity Increases the Risk of Getting Bullied

Bullying affects more than just those children who are seen to be isolated and marginalised, according to sociologists.

In fact, researchers have found that the 'popular' students are affected and may actually suffer more from a single act of social aggression.

"We did find that students who are isolated do get bullied," said Diane Felmlee, professor of sociology, Penn State.

Diane Felmlee
"However, for most students, the likelihood of being targeted by aggressive acts increases as a student becomes more popular, with the exception of those at the very top."

In a study of students and their friendship networks in 19 North Carolina schools, the researchers found that the risk of being bullied drops dramatically only for the adolescents in the top five percent of the school's social strata.

Bullying may be a tactical form of aggression, according to the researchers, who report their findings in the current issue of American Sociological Review (pdf).

Young people who are attempting to climb in status may increase their risk of victimization.

Robert Faris
"When youth are vying for status, they probably gain little from attacking students who are already marginalised, in fact, it might backfire," said Felmlee, who worked with Robert Faris, associate professor, University of California Davis.

"But, if adolescents put down someone who is trying to be a leader in their group, or who constitutes a threat to their status, then there is a lot more to be gained."

Faris and Felmlee also found that girls are more likely to be victims of both male and female bullies. Girls who date are at increased risk of physical violence.

"Girls may pose particular threats to other female students' social standing and represent potential rivals when it comes to securing a boyfriend," said Felmlee.

"For boys, girls who date represent rewarding, often popular and relatively easy targets who are unlikely to retaliate physically."

Students who have an aggressive friend tend to avoid being victimized. This may be further evidence that bullying is rarely an individual act, but associated with how friends establish and maintain hierarchies by protecting their own, according to the researchers.

There are serious costs associated with bullying over time, Felmlee said. Victims suffer elevated levels of anxiety, depression and anger. They tend to develop negative feelings about their schools, as well.

Bullying's detrimental effects can be even more pronounced among relatively popular students, according to the researchers.

Higher status students experienced significantly larger increases in depression, anxiety and anger than low-status students.

The friendships of these students also deteriorated.

"The effects of social aggression were magnified by the student's friendship status," said Felmlee.

"It may be that the kids who are extremely popular and rarely victimized had farther to fall than those more accustomed to being a target, so, although socially vulnerable youth suffer significantly from frequent harassment, more central victims of bullying, those who may be 'hidden in plain sight' face serious consequences."

The researchers examined data from the Context of Adolescent Substance Use study, which surveyed about 4,200 middle and high school students twice during the school year.

The surveys included questions on serious verbal and physical harassment, but did not include minor incidents, such as playful teasing.

The students were asked to provide information about their friendships, as well as information about students whom they believe they harassed and about those who they believe harassed them.

Wednesday, March 26, 2014

Dyslexia: TUC Guidelines

The TUC has published the third edition of its guide to dealing with dyslexia in the workplace.

Several million working age adults have dyslexia, which can cause problems with performance, organisation of work and time management, with around four per cent of the population seriously affected by the condition.

Workers can face real difficulties at work if their dyslexia is not diagnosed or if appropriate adjustments to their working conditions and environment are not made.

Union reps can play a vital part in supporting work colleagues with dyslexia and negotiating solutions with employers, says the guide.

The new edition of Dyslexia in the Workplace is a major rewrite of the original handbook, taking account of changes in the law and in good practice.

The guide includes an outline of the main issues around dyslexia, how to identify whether an employee is dyslexic, how to undertake proper workplace assessments and how companies can do more to support staff with the condition.

TUC General Secretary Frances O’Grady said: “All too often, workers with dyslexia can find themselves facing disciplinary action over perceived failures, when early awareness of the condition could have led to sensible solutions being identified.

“Our new workplace guidance gives union reps and employees the information they need to support dyslexic work colleagues and sort out any workplace problems.”

  • Dyslexia in the Workplace: a TUC Guide by Brian Hagan (3rd edition 2014) is available from TUC publications for £5 (trade unions and union members) or £15 (all others).
  • Readers can view a copy of the handbook here 
  • The TUC is organising Fair Pay Fortnight from Monday 24 March to Sunday 6 April. It will be a series of events across England and Wales to raise awareness about falling living standards. 
  • All TUC press releases can be found here

Tuesday, March 25, 2014

Mobile devices enable reading in those with dyslexia - Dr. Matthew H. Schneps

Dr. Matthew H. Schneps
The widespread advent of electronic books is beginning to break down barriers that previously restricted access to high-quality content for education, needed to support the economic betterment and well being of peoples worldwide. 

Even as electronic books promise to improve access to text, many will nevertheless be unable to benefit from these advances because of neurological disabilities (e.g., dyslexia) that make reading a struggle.

In this presentation Dr. Matthew H. Schneps describe new research that shows; when handheld mobile devices capable of displaying text (e.g., smartphones) are configured in prescribed ways, many with dyslexia are able to read with less effort and more quickly, with better comprehension, making fewer errors in reading.

Virtually no training is required on the part of the reader to benefit from this effect on mobile devices.

However, for the method to work, text material must be prepared and displayed in specific ways, and this requires an understanding of the relevant parameters at play.

The Smithsonian Institution in the US has initiated an outreach program to help educators learn how to use mobile devices in this way, and are seeking help and guidance from participants of UNESCO Mobile Learning Week 2014 to help disseminate this information outside the US.

Watch the Presentation here - Matthew H. Schneps

Dr. Matthew H. Schneps is the director of the Laboratory for Visual Learning (LVL) at the Harvard-Smithsonian Center for Astrophysics (CfA).

A founding member of the Science Education Department there, Schneps has been carrying out research and outreach in science education since 1983.

He is well known for his work in educational television media that includes the award-winning programs "A Private Universe", and "Minds of Our Own" broadcast worldwide (famous for scenes of Harvard and MIT graduates struggling with concepts about the seasons).

In recent years he has been conducting research in cognitive psychology to investigate how individual differences in neurology, including those associated with dyslexia, ADHD, and autism spectrum disorders, effects how people learn science.

An outgrowth of this work is the development of an innovative technique for reading for people with dyslexia using mobile devices, research carried out through funding from the National Science Foundation in the US, and other sources.

Schneps was awarded the George E. Burch Fellowship in Theoretic Medicine and Affiliated Sciences in 2010 – 2012.

Schneps has been continuously employed at the CfA since receiving his PhD in physics from MIT in 1979.

Saturday, March 22, 2014

AspienGirl: A book series on girls and women with Asperger Syndrome or High Functioning Autism

Tania Marshall, M.Sc. is a psychologist who specializes in Autism Spectrum Conditions.

In particular, Girls and Women with Asperger Syndrome or High Functioning Autism.

Tania is currently undertaking doctoral studies and is excited to be releasing her book series, designed specifically for females on the Autism spectrum and their carers, friends, family members and professionals.

Tania currently spends her professional time divided between private practice, research, and writing and looks forward to releasing the next installment in her AspienGirl™ book series.

Friday, March 21, 2014

Decoding Dyslexia Poster

Easy to remember list of accomodations for students with Dyslexia.